HUBUNGAN KEPATUHAN PEMBATASAN CAIRAN TERHADAP TERJADINYA EDEMA POST HEMODIALISA PADA PASIEN GAGAL GINJAL KRONIK DI RUMAH SAKIT AMINAH KOTA TANGERANG

Adherence is defined as the degree to which the patient carries out the treatment and behavior recommended by the doctor or others, in achieving the goals. IDWG is an increase in fluid volume with an increase in body weight as a basis for knowing the amount of fluid that enters during the interdialytic period, Edema is an excessive accumulation of fluid between body cells or in various body cavities. This study aims to identify the relationship between adherence to fluid restriction and the occurrence of post HD edema in CKD patients at Aminah Hospital Tangerang City in 2021, there were 68 people and post HD patients participated in this study using the Random Sampling technique. Researchers collected data using instruments. The post HD fluid restriction compliance instrument used in this study was a standardized questionnaire based on the Morisky compliance questionnaire (MMAS), while for the edema instrument in patients with chronic kidney failure the researcher used observational techniques, namely body weight measurement using a weight scale measuring instrument and using data patient medical record. Statistical test using Spearman Rank statistical test. Based on the results of the study obtained with a p value = 0.000 or <0.05, it can be concluded that there is a significant relationship between fluid restriction adherence to the occurrence of Post Hemodialysis Edema with a value of r = 935. Abstrak Kepatuhan didefinisikan sebagai tingkat penderita melaksanakan cara pengobatan dan perilaku yang disarankan oleh dokter atau yang lain, dalam mencapai tujuan. IDWG adalah peningkatan volume cairan dengan peningkatan berat badan sebagai dasar mengetahui jumlah cairan yang masuk selama periode interdialitik, Edema adalah penimbunan cairan secara berlebihan di antara sel-sel tubuh atau di dalam berbagai rongga tubuh. Penelitian ini bertujuan mengidentifikasi Hubungan Kepatuhan Pembatasan Cairan Terhadap Terjadinya Edema Post HD Pasien GGK di Rumah Sakit Aminah Kota Tangerang Tahun 2021, terdapat 68 orang dan pasien post HD berpartisipasi dalam penelitian ini dengan menggunakan teknik Random Sampling. Peneliti melakukan pengumpulan data menggunakan Instrumen. Untuk Instrumen kepatuhan pembatasan cairan post HD yang digunakan dalam penelitian ini adalah kuisioner baku berdasarkan kuisioner kepatuhan morisky (MMAS), sedangkan untuk instrument edema pada pasien gagal ginjal kronik peneliti menggunakan tehnik observasi, yaitu pengukuran berat badan menggunakan alat ukur timbangan berat badan serta menggunakan data rekam medis pasien. Uji statistik menggunakan uji statistik Spearman Rank. Berdasarkan hasil penelitian didapatkan dengan nilai p= 0,000 atau <0,05 maka dapat disimpulkan terdapat hubungan yang signifikan antara kepatuhan pembatasan cairan terhadap terjadinya Edema Post Hemodialisa dengan nilai r = 935.

Fluid Restriction Negatively Influences Perceived Morning Alertness and Visuomotor Ability

The purpose of this study was to assess the effect of two fluid intake protocols on alertness and reaction time before and after fluid intake. Healthy college-age males (n = 12) followed two fluid intake protocols on separate occasions: (1) prescribed fluid (PF) and fluid restricted (FR). In PF, participants were instructed to consume 500 mL of fluid the night prior to and the morning of data collection. In FR, participants were instructed to refrain from the consumption of fluid for 12 h. To assess hydration status, urine specific gravity and urine color were measured. Participants perceived level of thirst and alertness were also recorded. Participants then completed visuomotor reaction time tests using the Dynavision LED board, using both a central visuomotor test and a peripheral visuomotor test (PVRT) prior to (1) and following (2) the ingestion of 100 mL of water. Participants displayed significantly improved PVRT in PF state as compared to FR (PF1 = 1.13 ± 0.16, PF2 = 1.04 ± 0.14; FR1 = 1.27 ± 0.27, FR2 = 1.18 ± 0.20; p = 0.038, ηp2 = 0.363). Both CVRT and PVRT improved over time, following the ingestion of 100 mL of fluid. Participants in the PF state were also significantly more alert than participants in the FR state (PF = 4 ± 2, FR = 5 ± 2; p = 0.019, ES = 0.839). Collectively, perceived alertness and PVRT were negatively impacted by FR.

Decrease in the Use of Parenteral Fluids in Premature Infants from 31 to 34 Weeks of Gestation at Birth

Introduction: Some of the practices in medicine are carried out of habit without proven benefits. This is the case of premature babies from 31 to 34 weeks of gestation who are always given parenteral fluids, even though this practice has been associated with an increase incidence of infection. In 2017, we started a protocol of parenteral fluid restriction. To administer nutrition/fluids, we used oral fluids by suction if this was possible or otherwise by oral/nasogastric tube at volumes of 15-20 mL intake every 3 hours, with 5 mL increments every 12-24 hours until 200 mL/K/day was achieved, always using breast milk when possible.Material and methods: The present study sought to compare cases before and after this new policy. For this work, we review all premature babies between 31-34 weeks of gestation discharged home in two periods of time, the first from 01/01/2012 to 12/31/2017 and the second from 01/01/2018 to 08/31/2021. The number of cases with and without parenteral fluids (PF), the incidence of infection, the weight at admission and discharge, and the fall in the weight Z score between birth and discharge were compared. Both the anthropometric and outcome variables were compared using the different statistical methods according to each variable.Results: 725 cases were found with the described characteristics. The groups before and after the intervention did not show significant differences in their general demographic characteristics. A lower use of PF was observed in the second period from 348 cases (79%) to 70 (24%), p &lt;0.001 and fewer days of use (4.1 days/case vs 1.3, p &lt;0.0001) of PF. The weight at discharge and the change in weight Z-score were the same in both groups. Infections went from three cases to zero but it was not statistically significant. There were no complications due to less use of PF.Discussion: This study showed that the use of PF is not associated with significant changes in outcomes of interest, which reinforces that its use does not generate any benefit for the patient. Larger number of cases is required to detect differences in low incidence events such as infections.

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4–7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.

Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review

IntroductionExcessive water intake is rarely associated with life-threatening hyponatraemia. The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake.MethodsThis review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies (case reports, observational or interventional studies) reporting excess water intake and hyponatraemia in adults (1946–2019) were included.ResultsA total of 2970 articles were identified and 177 were included (88.7% case reports), consisting of 590 patients. The mean age was 46±16 years (95% CI 44 to 48 years), 47% female, 52% had a chronic psychiatric disorder and 31% had no underlying condition. The median volume of water consumed and serum sodium at presentation was 8 L/day (95% CI 8.9 to 12.2 L/day) and 118 mmol/L (95% CI 116 to 118 mmol/L), respectively. The motivator for increased water consumption was psychogenic polydipsia (55%); iatrogenic (13%); exercise (12%); habitual/dipsogenic polydipsia (7%) and other reasons (13%). The clinical features on presentation were severe in 53% (seizures, coma); moderate in 35% (confusion, vomiting, agitation) and mild in 5% (dizziness, lethargy, cognitive deficit) and not reported in 5% of studies. Treatment was supportive in 41% of studies (fluid restriction, treatment of the underlying cause, emergency care), and isotonic and hypertonic saline was used in 18% and 28% of cases, respectively. Treatment-related complications included osmotic demyelination (3%) and rhabdomyolysis (7%), and death occurred in 13% of cases.ConclusionWater intoxication is associated with significant morbidity and mortality and requires daily intake to substantially exceed population-based recommendations. The limitations of this analysis are the low quality and high risk of bias of the included studies.PROSPERO registration numberA pre-existing protocol in the international prospective register of systematic reviews was updated to incorporate any new amendments and reregistered at http://www.crd.york.ac.uk/PROSPERO (registration no. CRD42019129809).

Risk factors and outcomes associated with postoperative ileus following ileostomy formation: a retrospective study

Background Postoperative ileus (POI) is associated with increased patient discomfort, length of stay (LOS), and healthcare cost. There is a paucity of literature examining POI in patients who have an ileostomy formed at the time of surgery. We aimed to identify risk factors for and outcomes associated with POI following ileostomy formation. Methods We included 261 consecutive non-emergent cases that included formation of an ileostomy by a board-certified colorectal surgeon at our institution from July 1, 2015, to June 30, 2020. Demographic, clinical, and intraoperative factors associated with increased odds of POI were evaluated. Post-procedure LOS, hospitalization cost, and re-admissions between patients with and without POI were compared. Results Out of 261 cases, 85 (32.6%) were associated with POI. Patients with POI had significantly higher body mass index (BMI) than those without POI (26.6 kg/m2 vs. 24.8kg/m2; p = 0.01). Intraoperatively, patients with POI had significantly longer procedure duration than those without POI (313 min vs. 279 min; p = 0.02). Patients with POI had a significantly higher net fluid balance at postoperative day (POD) 2 than those without POI (+ 2.65 L vs. + 1.80 L; p = 0.004), with POD2 fluid balance greater than + 807 mL (determined as the maximum Youden index for sensitivity over 80%) associated with a higher rate of POI (p = 0.006). This difference remained significant when adjusted for age, gender, BMI, pre-operative opioid use, procedure duration, and operative approach (p = 0.01). Patients with POI had significantly longer LOS (11.40 days vs. 5.12 days; p < 0.001) and direct cost of hospitalization ($38K vs. $22K; p < 0.001). Conclusions Minimizing fluid overload, particularly in the first 48 h after surgery, may be a strategy to reduce POI in patients undergoing ileostomy formation, and thus decrease postoperative LOS and hospitalization cost. Fluid restriction, diuresis, and changes in diet advancement or early stoma intubation should be considered measures that may improve outcomes and should be studied more intensively.

Elderly with refractory chronic severe hyponatremia and anesthesia management dilemma: a case report with literature review

Hyponatremia is a common electrolyte disorder, especially in the frail elderly population. With the increasing number of surgeries in the aging population, hyponatremia is frequently encountered by anesthesiologists and surgeons. Unfortunately, management of hyponatremia is often complex in the elderly population as it is often multifactorial, and they are physiologically susceptible. While it is well known that preoperative hyponatremia is associated with increased perioperative morbidity and mortality, a lack of recommendations or guidelines adds to the dilemma in managing such cases. The most common cause of chronic hyponatremia in the elderly is the syndrome of inappropriate antidiuretic hormone (SIADH), which can be resistant to conventional treatment. On the other hand, paraneoplastic SIADH leading to hyponatremia is rare, and surgery may be the only option available for its correction. We present a case of a 78- years-gentleman to highlight such a dilemma. He was diagnosed with renal cell carcinoma and had chronic refractory severe hyponatremia despite treatment with fluid restriction, low dose hydrocortisone, tolvaptan, and 3% sodium chloride.

Impact of the nutritional status of children with congenital heart diseases on the early post-operative outcome

Background Children with congenital heart disease (CHD) frequently become malnourished due to many factors including hypermetabolic state, inadequate caloric intake, malabsorption, and fluid restriction as part of the hemodynamic intervention. The abnormal nutritional status may affect early outcome after pediatric cardiac surgery; we aim to prove the importance of nutritional assessment and patient nutritional preparation before performing pediatric cardiac surgery. Results We conducted a prospective observational cohort study from March 2013 till January 2015. All children from birth until 14 years of age admitted to the pediatric cardiac intensive care unit (PCICU) after cardiac surgery. Nutritional status was assessed preoperatively and prognostic nutritional index (PNI) was calculated. All post-operative outcome parameters, PCICU and hospital length of stay (LOS), ventilation time, the rate of infection, and ICU mortality were recorded. Two hundred fifty-nine children were evaluated. At admission, 179 patients (69%) had intake less than 50% of the recommended daily allowance (RDA) of calories intake. There was a statistically significant relationship between pre-admission RDA and the infection rate (P value 0.018). Severely malnourished patients had significantly longer ICU length of stay (LOS) (P value = 0.049). Similarly, weight and height percentiles have a significant effect on ICU LOS (P value 0.009 and 0.045) respectively. There was a significant relation between PNI ≥ 55 and the ICU LOS (P < 0.05), and ventilation time (P = 0.036). Delay in feeding postoperatively was associated with a higher risk of infection (P = 0.005), and higher mortality (P = 0.03). Conclusions Children with CHD were significantly malnourished preoperatively and had further weight loss postoperatively. Preoperative nutritional status and delayed postoperative enteral feeding were associated with a higher infection rate and mortality.

PERBEDAAN KEPATUHAN PEMBATASAN CAIRAN PASIEN GAGAL GINJAL KRONIK (GGK) ANTARA PASIEN YANG DIBERIKAN EDUKASI MENGGUNAKAN MEDIA AUDIOVISUAL DENGAN LEAFLET DI RUANG HEMODIALISA RSUD DR. SAIFUL ANWAR MALANG

ABSTRACT One of the treatments to save the life of patients with chronic renal failure is hemodialysis therapy, accompanied by fluid intake restriction. This research aimed to figure out the effect of health education using audiovisual media on fluid restriction of Chronic Kidney Failure patients in the Hemodialysis Room of RSUD Dr. Saiful Anwar Malang. This research was a quantitative approach with a quasi-experimental design with a pretest-posttest approach with control group design. The sampling technique used in this research is purposive sampling. In the control group, the score of adherence to fluid restriction in CKD patients was significantly different (p=0.000). In the treatment group, the score of adherence to fluid restriction in CKD patients was significantly different (p=0.000). There was a difference in adherence scores after education between the control group and the experimental group (p=0.040). Education using audio-visual is very effective for increasing one's knowledge. So it is recommended that the next researchers to conduct health education research using the audio-visual method more than one meeting. Keyword: Health Education, Chronic Kidney Disease (CKD), Fluid Intake ABSTRAK Salah satu penanganan untuk menyelamatkan nyawa pasien Gagal Ginjal Kronik adalah terapi hemodialisis, disertai pembatasan asupan cairan. Tujuan dari penelitian ini untuk mengetahui pengaruh pendidikan kesehatan media audivisual terhadap pembatasan cairan pasien Gagal Ginjal Kronik di Ruang Hemodialisa RSUD Dr. Saiful Anwar Malang.Penelitian ini menggunakan pendekatan kuantitatif desain Quasi Eksperiment Teknik sampling yang digunakan purposive sampling. Pada kelompok kontrol, skor kepatuhan pembatasan cairan pada pasien GGK berbeda signifikan (p=0.000). Pada kelompok perlakuan, skor kepatuhan pembatasan cairan pada pasien GGK berbeda signifikan (p=0.000). Terdapat perbedaan skor kepatuhan sesudah edukasi antara kelompok kontrol dan kelompok eksperimen (p=0.040). Edukasi menggunakan audio visual sangat efektif untuk meningkatkan pengetahuan seseorang, sehingga disarankan kepada peneliti selanjutnya untuk melakukan penelitian pendidikan kesehatan menggunakan metode audio visual lebih dari satu kali pertemuan. Kata Kunci: Pendidikan kesehatan, Gagal Ginjal Kronik, Asupan Cairan